There has been a lot of media attention about the newest guidelines for Pap testing, which in turn brings up a lot of questions. Pap tests (named after Dr. Papanicolaou) are part of routine well-women care, used to screen for pre-cancerous and cancerous cervical lesions. Guidelines are published by medical organizations to be used by medical practitioners to help inform their clinical practice, using the most up-to-date evidence and research available. However, guidelines are just that - they are a guide - and it is important for all women to to have a discussion with their practitioner, and create an individualized plan of care that is right for you.
The current guidelines for Pap Testing in women of
average-risk:
- Initiate Pap Test at age 21 years, regardless of sexual history.
- Pap Test every 3 years from 21 through 29.
- Pap Test with HPV test (co-testing) every 5 years from 30 through 65, or Pap Test alone every 3 years.
- Stop screening after age 65, or after total hysterectomy with cervical removal (for non-cancerous reason).
The following table shows the guidelines from different medical organizations, which are in agreement regarding screening for average-risk women. It is important to discuss your Pap history with your provider, and determine your best screening schedule.
The annual well-women exam is often where Pap Testing is done; however, just because you don't need an annual every year does not mean you should skip your annual. Having an annual exam is part of routine health maintenance and disease prevention - making sure you are up to date with other screening recommendations, a clinical breast exam, immunizations, lab work, discussing healthy behaviors, and of course answering any questions you have about your health.
With the new Affordable Care Act, as of 2010 preventative services, including an annual exam and recommended screenings, are all covered 100% by your insurance!
Women need to be so careful, the excess in women's healthcare is much more likely to worry and harm us. The routine breast and bimanual pelvic exam have not been recommended for many years in the UK, Australia, much of Europe etc. The evidence for the exam is poor and it carries risk. The routine breast exam...no evidence of benefit, but it leads to excess biopsies. The routine pelvic exam is not a screening test for ovarian cancer and is not recommended at any age in asymptomatic women in many countries. I'm 55 and have never had either exam.
ReplyDeleteDr Carolyn Westhoff, the American Ob-gyn, partly blames this exam for their high hysterectomy rates, 1 in 3 women will have one by age 60, and for the loss of healthy ovaries....more than twice the number carried out in countries who don't perform this exam.
Pap testing and breast screening, well, don't believe the hype, look at the evidence and make an informed decision. Most women cannot benefit from pap testing, it just risks their health exposing them to false positives and potentially harmful over-treatment. Damage to the cervix can mean premature babies, infertility, c-sections, cervical cerclage, miscarriages etc.
The Netherlands and Finns have put the evidence and women first, since the 1960s the Finns have had a 6-7 pap test program, 5 yearly from age 30 to 60 and they have both the lowest rates of cc in the world and refer FAR fewer women for biopsies etc.
Excessive testing increases the risk of a false positive for no additional benefit to women.
The Dutch had the same program, but will scrap population pap testing that worries and harms so many, it's a huge burden to the vast majority of women who can never benefit. The Dutch will offer 5 hrHPV primary tests or self-test with the Delphi Screener at ages 30,35,40,50 and 60 and ONLY the roughly 5% who are HPV+ and at risk will be offered a 5 yearly pap test. This will save more lives and spare most women from a lifetime of unnecessary pap testing and take them out of harms way.
Some countries will never offer women evidence based testing or self-testing, vested interests will protect the enormous profits made from non-evidence-based testing and excess for as long as possible.
Women need to do their reading and make an informed decision. Screening is our decision and we need real and balanced information to make an informed decision.
So many women are being worried and harmed by excess. I made an informed decision more than 30 years ago not to screen and more recently declined breast screening. Real information on breast screening is easy thanks to the Nordic Cochrane Institute, who've produced an excellent summary of the evidence to enable women to make an informed decision to accept or decline testing. The evidence is concerning, about 50% of screen detected breast cancers are over-diagnosed, the fall in the death rate is about better treatments, not screening, and the risks with screening exceed any benefit when you consider women who die from heart attacks and lung cancer after treatment, including chemo and radiotherapy. (Professor Michael Baum's article in the BMJ, 2013)
The American system is frightening, pure and hugely profitable
excess which is not in the interests of women. Medical coercion to force women to test and into excess to get the Pill should be stopped, it would be a very serious matter if it occurred here,
involving the Medical Board. (at the very least)
HPV Today, Edition 24, sets out the new Dutch program. The NCI website contains the breast screening brochure.
EEB(Aust)
Thank you for your comment - you bring up good points about making choices for yourself about your own health and how you utilize the health care system, which is of course very individualized. We all make choices every single day in our lives that impact our health - what we eat, exercise, how much sleep we get, etc. Exams and tests can be very helpful if used appropriately and effectively, and can be harmful if used inappropriately. This is why it is important to have a relationship with your health care provider, and have the space to discuss and decide as partners in your health what screening, exams, lab work, etc. would be beneficial. Each person is different, so there is no "one size fits all" solution in health - guidelines are used by providers as a place to start, but can be tailored for each person. Thanks for your response!
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